QUESTION:
Dear Dr. Heller,
Since coming to see you 2 years ago, my daughter has improved dramatically. She is no longer depressed and has had no dysphoric symptoms in over 18 months. She takes 80mg of Prozac along with BuSpar and Tegretol. However, there is one major issue remaining, and that is her weight gain. She does not overeat or binge, but she has gained 65 pounds in the last 18 months. Her thyroid levels are fine. She initially lost ten pounds on Prozac and then gained 30 before we came to see you. Now she has gained 50 more and weighs over 200 pounds and is only 5'2". A number of people I know have gained weight on Prozac and lost weight using Wellbutrin. Is it possible to cut back on her Prozac to 20-40mg and add Wellbutrin, or replace the Prozac completely and use Wellbutrin instead?
ANSWER:
I'm obviously thrilled to hear that she's doing well.
The most common reason is untreated cognitive generalized anxiety disorder (GAD). This
"genetic worry" is due to an elevated serotonin #1 receptor, which gets
increased from Prozac and other SSRI's. Many of these patients "treat"
their increased anxiety with food. It's a true "chemical imbalance".
There is another "chemical imbalance" - where the
serotonin/noradrenaline/dopamine levels get out of balance from the SSRI medication
(Prozac in this case). Wellbutrin can be added to put these levels back into balance. If
the OCPD or OCD is being treated with the high Prozac doses, they will need to stay high -
even when Wellbutrin is added. If not, lower Prozac doses can be used.
Wellbutrin SR 100mg twice daily for a week, increasing to 150mg twice daily is the usual
approach. Those consuming caffeine can get severe headaches from Wellbutrin.
Wellbutrin can also help with sexual side effects from SSRI's like Prozac.
